A new Connecticut law imposes more stringent restrictions on health insurance companies, including new billing regulations and additional hurdles for insurers that purchase physician groups.
The acquisition of physician groups "has emerged as a recent trend as health insurers attempt to control costs and increase the quality of healthcare," a JD Supra article notes. For example, UnitedHealthGroup's Optum unit has allowed the country's largest insurer to expand its patient care offerings, an effort it began four years ago when it agreed to handle nonclinical operations at some Californian large physician groups, FierceHealthPayer has reported.
Currently, Connecticut law requires entities whose transaction significantly changes the structure of a physician group to submit written notice to the state's attorney general, according to JD Supra. The new regulations also ask both parties to submit a written notice to the state's department of health, which will notify consumers via its website.
Also in the spirit of transparency, the new law requires health insurers to submit pricing and reimbursement information to both the state and to consumers. For example, they must report to the Connecticut Health Insurance Exchange in-network billed and allowed provider payments, as well as out-of-pocket costs, for a set group of diagnoses and procedures.
The law also contains a set of regulations regarding the type and understandability of plan information insurers provide to enrollees. For example, some health insurance companies must, by Jan. 1, provide information on their websites that detail plans' coverage inclusions and exclusions for consumers at the time of enrollment.
Nearly half of uninsured Americans lack confidence when it comes to selecting the right health plan.
To learn more:
- here's the law (.pdf)
- read the JD Supra report